Surgical device and endoscope including same

ABSTRACT

A surgical device for use with an endoscope. The device includes an end cap removably affixable to a distal end of the endoscope such that at least a portion of the end cap distally extends beyond the distal end of the endoscope. The end cap defines a through bore for receiving the distal end of the endoscope, and the end cap includes an outer surface defining first and second tracks substantially perpendicular to a longitudinal axis of the through bore. The device further includes a first working channel having a distal end disposed in the first track and movable along a length of the first track between a first position and a second position. The device further includes a second working channel having a distal end disposed in the second track and movable along a length of the second track between a first position and a second position. The distal end of each the first and second working channel defines a bore having a longitudinal axis substantially perpendicular to the longitudinal axis of the through bore of the end cap.

BACKGROUND

Minimally invasive surgical procedures are desirable because such procedures can reduce pain and provide relatively quick recovery times as compared with conventional open medical procedures. Many minimally invasive procedures are performed with an endoscope. Such procedures permit a physician to position, manipulate, and view medical instruments and accessories inside the patient through a small access opening in the patient's body. Laparoscopy is a term used to describe such an “endosurgical” approach using an endoscope (often a rigid laparoscope). In this type of procedure, accessory devices are often inserted into a patient through trocars placed through the body wall.

Still less invasive treatments include those that are performed by inserting an endoscope through a natural body orifice to a treatment site. Examples of this approach include, but are not limited to, cystoscopy, hysteroscopy, esophagogastroduodenoscopy, and colonoscopy. Many of these procedures employ the use of a flexible endoscope during the procedure. Flexible endoscopes often have a flexible, steerable articulating section near the distal end of a shaft that can be controlled by the user by utilizing controls at the proximal end.

Some flexible endoscopes are relatively small (1 mm to 3 mm in diameter), and may have no integral working channel. Other flexible endoscopes, including gastroscopes and colonoscopes, have integral working channels having a diameter of about 2.0 to 3.5 mm for the purpose of introducing and removing medical devices and other accessory devices to perform diagnosis or therapy within the patient. Certain specialized endoscopes are available, such as large working channel endoscopes having a working channel of 5 mm in diameter, which can be used to pass relatively large accessories. Other specialized endoscopes include those having two working channels.

Many accessories, sheaths, overtubes, attachments, and other types of medical apparatuses have been developed for use with endoscopes for various purposes. For example, overtubes that cover the shaft of the endoscope have been developed to help keep the endoscope clean or to provide auxiliary endoscopic passageways or guides into the patient's body. Some of these apparatuses include an attachment device or end cap that may be affixed to the endoscope tip. Some end caps may be clamped or pressed tightly onto the endoscope tip. See, e.g., U.S. patent application Ser. No. 10/440,957 entitled “Medical Apparatus for Use with an Endoscope” to Stefanchik et al., filed May 16, 2003. Separate accessory channels have also been developed for use in conjunction with a conventional endoscope to facilitate the introduction of additional surgical tools or accessories.

Medical instruments introduced into a patient using a multi-channel endoscope emerge from the working channels in a direction generally parallel to the axis of the endoscope. This orientation of the instruments may be problematic for procedures in which surgical tasks (e.g., retraction and cutting) are required to be performed simultaneously at different angles relative to the longitudinal axis of the endoscope. Additionally, while the ability to apply a distally-directed force to an area of the treatment site using the distal end of the endoscope could be potentially useful for certain procedures, generating such force by pushing a flexible endoscope from its proximal end has heretofore proved difficult, as these instruments typically lack the stiffness and rigidity necessary to effectively transfer the pushing force over the instrument's length. What is needed is an improvement over the foregoing.

FIGURES

The novel features of the various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with further advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows:

FIG. 1 is a perspective view of a surgical device according to one embodiment;

FIG. 2 is a perspective view of the disassembled device of FIG. 1;

FIGS. 3A-3B are perspective views of the end cap and working channels of FIG. 1 in a disassembled state;

FIGS. 4A-4B are proximal views of the working channels of FIG. 1 in first and second positions, respectively, relative to the end cap of FIG. 1 according to one embodiment;

FIGS. 5A-5C are views of the translating mechanism and the end cap of FIG. 1;

FIG. 6 is a proximal view of the end cap, working channels, and translating mechanism of FIG. 1;

FIG. 7 is a perspective view of the working channels of FIG. 1 according to one embodiment;

FIGS. 8A-8B illustrate side views of the actuator of FIG. 1 and its operation according to one embodiment;

FIG. 9 is a proximal view of the end cap, working channels, and translating mechanism of FIG. 8B;

FIGS. 10A-10B are perspective views of the device of FIG. 1 with the end cap affixed to a distal end of an endoscope;

FIGS. 11A-11B illustrate uses of the device of FIG. 1 in conjunction with an endoscope according to various embodiments; and

FIG. 12 is a perspective view of a distal tip of an endoscope according to one embodiment.

DESCRIPTION

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate preferred embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present application.

Embodiments of the present application are directed to devices and methods for placing and using one or more medical instruments or accessory devices within a patient's body. The devices and methods utilize an end cap comprising a through bore into which a distal end of an endoscope may be affixably received. An outer surface of the end cap defines a pair of tracks within which distal ends of a pair of working channels are correspondingly disposed such that each distal end is moveable between a first position and a second position relative to its respective track. The first position of the distal ends may correspond to a non-deployed, or “stowed,” position wherein the distal ends are predominantly recessed within the end cap so as to reduce the cross-sectional profile of the device at its distal end, thereby enhancing endoscope insertability. The second position of the distal ends may correspond to a deployed, or “operational,” position wherein one or more medical instruments or accessory devices may be introduced to a treatment site within the patient's body via the distal ends of the working channels in order to, for example, manipulate tissue of the treatment site relative to the end cap in a desired manner. Such instruments or accessories may include, for example, grasper devices for pulling tissue tightly over a distal tip portion of the end cap in order to effect localized retraction.

The devices and methods may also utilize a translating mechanism coupled to the end cap and the distal end of each working channel, and an actuator coupled to the translating mechanism. The actuator may be contained in a handle portion positioned adjacent the proximal end of the endoscope, and may operate to cause the translating mechanism to move the distal ends of the working channels in unison between the first and second positions.

Turning to the drawings, FIGS. 1-2 are perspective assembled and disassembled views, respectively, of one embodiment of a surgical device 10 for use with an endoscope, such as a flexible endoscope, for example. The device 10 may comprise an end cap 20, a first working channel 30 a and a second working channel 30 b, with each working channel 30 a, 30 b having a distal end 40 a, 40 b, respectively, movably coupled to the end cap 20. The device 10 may further comprise a translating mechanism 50 coupled to the end cap 20 and to the distal end 40 a, 40 b of each working channel 30 a, 30 b, and a handle portion 60 coupled to the end cap 20 and working channels 30 a, 30 b via the translating mechanism 50. The handle portion 60 may comprise a pistol grip 70 graspable by a clinician during use of the device 10, and an actuator 80. In certain embodiments and as discussed below, the actuator 80 may be manually operated by a user of the device 10 in order to effect movement of each distal end 40 a, 40 b of the working channels 30 a, 30 b between a first position and a second position relative to the end cap 20.

In an installed configuration of the device 10, the end cap 20 may be removably affixed to the distal end of an endoscope (FIGS. 10A-10B), with the handle portion 60 being positioned adjacent a proximal end of the endoscope. In this configuration, portions of the working channels 30 a, 30 b and portions of the translating mechanism 50 may be generally aligned with the endoscope shaft and, in some cases, be suitably anchored thereto. In FIGS. 1 and 2, although proximal portions of the working channels 30 a, 30 b have been omitted for the sake of visual clarity, it will be appreciated that the working channels 30 a, 30 b may extend proximally from the end cap 20 so as to be suitably accessible by a user of the device 10 and/or endoscope.

It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician gripping a handle portion 60 of the device 10. Thus, the end cap 20 is distal with respect to the more proximal handle portion 60. It will be further appreciated that, for convenience and clarity, spatial terms such as “upper” and “lower” are used herein with respect to the drawings. However, surgical devices are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

In certain embodiments and as shown in FIGS. 3A-3B, the end cap 20 may comprise a relatively rigid external body 90 defining a through bore 100. A relatively soft insert 110 may extend at least partially through the through bore 100 from its proximal end and comprise a gripping surface 120. Insert 110 and gripping surface 120 may be provided for removably affixing the end cap 20 to an endoscope, such that end cap 20 may be pushed onto the distal end of the endoscope and removed therefrom without the need for special tools or assembly techniques. One or more of the insert 110 and gripping surface 120 may comprise a sticky or tacky material such as silicone or neoprene, or a suitable adhesive, to retain the end cap 20 in place on the distal end of the endoscope. Alternatively, the end cap 20 may be removably affixed to the endoscope using a snap fit, an interference fit, or any other suitable non-permanent attachment means. In certain embodiments, the end cap 20 material may be sufficiently elastic such that the proximal opening of the through bore 100 may be stretched or otherwise expanded to accommodate the distal end of the endoscope and be retained thereon by frictional force, thus eliminating the need for the insert 110.

The external body 90 of the end cap 20 may be made from a biocompatible plastic, such as, for example, nylon 6/6, polycarbonate, or polyvinyl chloride (PVC), and may comprise a distal tip portion 130 and a proximal portion 140. Generally, the distal tip portion 130 is dimensioned such that when the end cap 20 is affixed to the distal end of an endoscope, the distal-most edge of the distal tip portion 130 distally extends a distance beyond the distal end of the endoscope (denoted in FIGS. 11A-11B and FIG. 12 as distance d). The distance between the distal-most edge of the distal tip portion 130 and the distal end of the endoscope may be determined by, among other things, the volume of space needed within the interior of the end cap 20 to manipulate one or more instruments placed therein via integral working channels of the endoscope. The distal tip portion 130 of the end cap 20 may have a variety of configurations depending on the intended use. In certain embodiments, at least a portion of the distal tip portion 130 may be constructed using a material that is suitably transparent or clear to allow an image gathering unit at the distal end of the endoscope to view and gather images through the distal tip portion 130. In certain embodiments, the distal tip portion 130 may be configured to enlarge an opening in tissue as it is advanced through the tissue and/or to provide localized retraction, for example, by pulling an area of the treatment site over the distal tip portion 130 using grasper devices external to the endoscope. In certain embodiments, the distal tip portion 130 may be made of a soft, compressible material. In certain embodiments, the distal-most edge of the distal tip portion 130 may comprise an oblique or non-oblique contour.

The proximal portion 140 of the end cap 20 may be substantially cylindrical in shape and comprise an outer surface 150 defining first and second recesses 160 a, 160 b. Each recess 160 a, 160 b may comprise a planar distal wall portion 170 a, 170 b and a contoured seat portion 180 a, 180 b, with each seat portion 180 a, 180 b defining a straight, recessed track 190 a, 190 b substantially perpendicular to a longitudinal axis of the through bore 100. In an assembled state of the device 10 (FIG. 1), the distal ends 40 a, 40 b of the working channels 30 a, 30 b may be correspondingly seated within the first and second recesses 160 a, 160 b such that a longitudinal axis of each distal end 40 a, 40 b is generally aligned with the longitudinal axis of the through bore 100, and such that each working channel 30 a, 30 b is longitudinally positioned adjacent, or in contact with, the corresponding distal wall portion 170 a, 170 b. In certain embodiments and as shown in FIGS. 3A-3B, an outer surface of each distal end 40 a, 40 b may comprise a raised ring 200 a, 200 b, respectively, positioned coaxially thereon. The dimensions of each ring 200 a, 200 b and its position on the distal end 40 a, 40 b may be such that, when the distal ends 40 a, 40 b are seated within their respective recesses 160 a, 160 b, each ring 200 a, 200 b is slidingly received into the track 190 a, 190 b defined by the corresponding seat portion 180 a, 180 b. As discussed below, the distal end 40 a, 40 b of each working channel 30 a, 30 b may be retained within its corresponding recess 160 a, 160 b by virtue of its attachment to a corresponding distal portion of the translating mechanism 50.

In the seated position, the distal end 40 a, 40 b of each working channel 30 a, 30 b is movable along a length of its corresponding track 190 a, 190 b between a first position and a second position. The longitudinal alignment and longitudinal position of each distal end 40 a, 40 b relative to the end cap 20 may be maintained substantially constant throughout its range of motion by virtue of the sliding cooperation between the rings 200 a, 200 b and their corresponding tracks 190 a, 190 b. In certain embodiments, the first position of the distal ends 40 a, 40 b may correspond to an un-deployed or “stowed” configuration wherein the position of the distal ends 40 a, 40 b relative to their respective tracks 190 a, 190 b is such that a cross-sectional area of a distal portion of the device 10 is minimized or reduced. This position of the distal ends 140 a, 140 b may be employed, for example, during passage of the distal end of the endoscope through an overtube or other passage way in order to enhance instrument insertion and withdrawal. In certain embodiments, the second position of the distal ends 40 a, 40 b may correspond to a deployed, or “operational,” configuration wherein the position of the distal ends 40 a, 40 b relative to their respective tracks 190 a, 190 b is such that medical instruments or accessories may be distally extended from the working channels 30 a, 30 b and beyond the distal tip portion 130 of the end cap 20 in order to, for example, manipulate an area of the treatment site relative to the end cap 20.

FIGS. 4A-4B are proximal views of the working channels 30 a, 30 b in first and second positions, respectively, relative to the end cap 20 according to one embodiment. In the first position, each distal end 40 a, 40 b is located within an upper portion of its corresponding recess 190 a, 190 b, with an outer surface of each distal end 40 a, 40 b seated against a conforming surface of the corresponding seat portion 180 a, 180 b. In this position, each distal end 40 a, 40 b is predominantly situated behind its respective distal wall portion 170 a, 170 b. In the second position, each distal end 40 a, 40 b is located within a lower portion of its corresponding recess 190 a, 190 b, with the outer surface of each distal end 40 a, 40 b seated against a conforming surface of the corresponding seat portion 180 a, 180 b. In this position, the distal ends 40 a, 40 b may be opposingly oriented, or nearly so, relative to the through bore 100 of the end cap 20. As shown in FIGS. 3A-3B, the outer surface 150 of the end cap 20 may partially define clearance recesses 210 a, 210 b extending distally from the distal wall portions 170 a, 170 b at the bottom of the recesses 160 a, 160 b, respectively. The clearance recesses 210 a, 210 b may further extend into the distal tip portion 130 of the end cap 20. The dimensions of the clearance recesses 210 a, 210 b may be such that, when the distal ends 140 a, 140 b are moved into the second position, openings of the distal ends 140 a, 140 b are unobstructed by the distal wall portions 170 a, 170 b or other portions of the end cap 20, thus permitting medical instruments or accessory devices to be distally extended from the working channels 30 a, 30 b and beyond the distal tip portion 130 of the end cap 20.

Referring again to FIGS. 3A-3B, the end cap 20 may further comprise a first connecting channel 220, a second connecting channel 230, and a third connecting channel 240. The first connecting channel 220 may comprise internally-connected openings 250 a, 250 b, 250 c formed in a proximally-facing upper surface of the end cap 20, and in an upper portion of each track 190 a, 190 b, respectively. The second connecting channel 230 may comprise internally-connected openings 260 a, 260 b formed in a proximally-facing lower surface of the end cap 20, and in a lower portion of the track 190 a, respectively. The third connecting channel 240 may comprise internally-connected openings 270 a, 270 b formed in a proximally-facing lower surface of the end cap 20, and in a lower portion of the track 190 b, respectively. As discussed in further detail below, the connecting channels 220, 230, 240 may be used for coupling the translating mechanism 50 to the end cap 20 and to the distal ends 40 a, 40 b of the working channels 30 a, 30 b.

As shown in FIG. 1, a distal end of the translating mechanism 50 may be coupled to the end cap 20, and a proximal end of the translating mechanism 50 may be coupled to the handle portion 60. In addition to physically joining the handle portion 60 and the end cap 20, the translating mechanism 50 operates to direct forces generated by the actuator 80 within the handle portion 60 to the distal ends 40 a, 40 b of the working channels 30 a, 30 b so as to enable selective movement of the distal ends 40 a, 40 b between the first position and the second position.

According to various embodiments, the translating mechanism 50 may comprise one or more tubes having at least one translating member slidingly disposed therethrough. With reference to the embodiment of FIG. 2, for example, the translating mechanism 50 may comprise a first tube 280 a and a second tube 280 b through which a single translating member 290 is slidingly disposed. According to various embodiments and as described below, the translating member 290 may be formed of wire cable, although it will be appreciated that other suitable materials, such as, for example, wire, braided rope, or other flexible cord, may be used instead. The first and second tubes 280 a, 280 b may be constructed from a biocompatible material having flexibility sufficient to permit the end cap 20 and the distal ends 140 a, 140 b to be positioned as needed relative to the handle portion 60.

Again referring to FIG. 2, the cable 290 may comprise a loop having a distal end 295 that is split to define a first cable segment 300 a and a second cable segment 300 b. The cable 290 may be disposed within the first and second tubes 280 a, 280 b such that the first and second cable segments 300 a, 300 b extend from split distal ends 310 a, 310 b, respectively, of the first tube 280 a, and such that the first and second cable segments 300 a, 300 b both extend from a distal end 320 of the second tube 280 b. In this way, two cable loops are formed between the distal ends of the first and second tubes 280 a, 280 b, with the first loop extending between distal end 310 a of the first tube 280 a and the distal end 320 of the second tube 280 b, and the second loop extending between distal end 310 b of the first tube 280 a and the distal end 320 of the second tube 280 b.

In the assembled state of the translating mechanism 50 and the end cap 20, as shown in FIGS. 5A-5C, distal end 320 of the second tube 280 b may connect to the proximally-facing opening 250 a of connecting channel 220, and distal ends 310 a, 310 b of the first tube 280 a may connect to the proximally-facing openings 260 a, 270 a of connecting channels 230, 240, respectively. In this way, a portion of the first cable segment 300 a may be routed over the track 190 a via openings 250 b and 260 b, and a portion of the second cable segment 300 b may be routed over the track 190 b via openings 250 c and 270 b. It will thus be appreciated that by translating a portion of the cable 290 proximally located with respect to the first and second cable segments 300 a, 300 b, a corresponding translation of the portions of the first and second cable segments 300 a, 300 b passing over the tracks 190 a, 190 b, respectively, will result.

FIG. 6 is a proximal view of the end cap 20, the working channels 30 a, 30 b, and the translating mechanism 50 in an assembled state. As shown, the distal ends 40 a, 40 b of the working channels 30 a, 30 b are in the first position as described above in connection with FIG. 4A, and each is retained within its respective recess 160 a, 160 b by attachment of its corresponding ring 200 a, 200 b to a portion of the first and second cable segments 300 a, 300 b passing over each track 190 a, 190 b, respectively. Attachment of each cable segment 300 a, 300 b to its corresponding ring 200 a, 200 b may be accomplished, for example, by passing the cable segment 300 a, 300 b through a slot 330 a, 330 b (FIG. 7) formed in the ring 200 a, 200 b. The cable 290 may be tensioned in order to retain the distal ends 40 a, 40 b in their respective recesses 160 a, 160 b with a suitable amount of force.

FIGS. 8A-8B illustrate side views of the actuator 80 and its operation according to one embodiment. The actuator 80 may comprise a manually-operated knob 340 coupled to a shaft 350. With reference to FIGS. 1-2, the knob 340 may be located on a top external surface of the handle portion 60, with the shaft 350 rotatably disposed within the pistol grip 70. Proximal ends 360 a, 360 b of the first and second tubes 280 a, 280 b may connect to the handle portion 60 such that a proximal end 370 of the cable 290 is received therein. The proximal end 370 may be wound around the shaft 350 such that rotation of the knob 340 by a user of the device 10 causes rotational force to be applied to the cable 290, thus causing the cable 290 to translate axially though the tubes 280 a, 280 b.

In FIG. 8A, the distal ends 40 a, 40 b of the working channels 30 a, 30 b are shown in a first portion within an upper portion of their respective recesses 160 a, 160 b. In FIG. 8B, the knob 340 has been rotated counter-clockwise relative to its position in FIG. 8A, thus resulting in the axial translation of the cable 290 through the tubes 280 a, 280 b and the concomitant downward movement of the cable segments 300 a, 300 b over their respective tracks 190 a, 190 b. The distal ends 140 a, 140 b of the working channels 130 a, 130 b, by virtue of their attachment to the cable segments 300 a, 300 b, have been transitioned in unison to a second position within a lower portion of their respective recesses 160 a, 160 b. FIG. 9 is a proximal view of the end cap, working channels, and translating mechanism of FIG. 8B. It will be appreciated that in certain embodiments, movement of the distal ends 40 a, 40 b between the first and second positions may require portions of the working channels 30 a, 30 b to suitable flex. Accordingly, the working channels 30 a, 30 b may be constructed of a suitably flexible biocompatible material.

FIGS. 10A-10B are perspective views of the device 10 with the end cap 20 affixed to a distal end 380 of an endoscope 390. In certain embodiments, the end cap 20 may be removably affixed to the distal end 380 by first aligning the longitudinal axis of the through bore 100 at its proximal end with a longitudinal axis of the distal end 380 of the endoscope. If necessary, the end cap 20 may be rotated about the longitudinal axis of the through bore 100 such that a desired rotational orientation of the end cap 20 relative to the distal end 380 is achieved. Next, the end cap 20 may be pushed onto the distal end 380 of the endoscope 390 with a suitable amount of force such that the distal 380 end is received into the bore 100 and removably retained therein, for example, by virtue of its engagement with the gripping surface 110 of the insert 120 (FIGS. 3A-3B).

In certain embodiments, a portion of the working channels 30 a, 30 b and a portion of the translating mechanism 50 may fastened to an external surface of the endoscope 390. In one embodiment and as shown in FIGS. 10A-10B, for example, one or more fasteners 400 may be provided over a length of the endoscope 390 shaft such that portions of the working channels 30 a, 30 b and portions of the tubes 280 a, 280 b are externally anchored to the endoscope 390 shaft and maintained in general alignment therewith. The one or more fasteners 400 may generally comprise any type of mechanical fastening device or material (e.g., zip fasteners, tape, adhesive) suitable for use in medical applications. In addition or as an alternative to the one or more fasteners 400, one or more sleeves (not shown) made from a suitably flexible material may be used to enclose portions of the working channels 30 a, 30 b and portions of the tubes 280 a, 280 b, as well as corresponding portions of the endoscope 390 shaft, such that the enclosed portions are collectively maintained in general alignment. It will be appreciated that the one or more fasteners 400 and/or sleeves should be sufficiently distanced from the end cap 20 so as not to interfere with the movement of the distal ends 40 a, 40 b, as shown in FIG. 10B.

FIGS. 11A-11B illustrate uses of the device 10 in conjunction with an endoscope 390 according to various embodiments. In FIG. 11A, the distal end 380 of the endoscope 390, with the end cap 20 affixed thereto, has been inserted through one or more openings in the patient (e.g., through a natural orifice and an internal incision) and advanced to a treatment site comprising an area of tissue 410. The distal end 40 a, 40 b of each working channel 30 a, 30 b has been subsequently moved into an operational position. Grasper devices 420 a, 420 b have been advanced through the working channels 30 a, 30 b, respectively, and extend from the distal ends 40 a, 40 b to grasp corresponding portions of the tissue 410 adjacent the end cap 20. The grasper devices 420 a, 420 b may be used to apply proximally-directed forces to the tissue 410 such that the tissue 410 is pulled tightly over the distal tip portion 130 of the end cap 20. This tensioned state of the tissue is well-suited for a number of endoscopic procedures, particularly cutting procedures in which the self-propagation of incisions can be realized by suitably tensioning the tissue 410. Although the tensioning effect of FIG. 11A might be realizable without the use of the grasping devices 420 a, 420 b if the end cap 20 could be pushed into the tissue 410 using distally-directed forces applied via the endoscope 390, this approach has heretofore proved problematic due to the general inability of flexible endoscopes to effectively transfer such forces over their entire length, as noted above. Additionally, achieving the tensioning effect of FIG. 11A using grasping devices deployed through working channels integral with the endoscope 390 is also difficult, as the application of pulling force from within the end cap 20 is generally not effective to uniformly tension the tissue 410 across the distal tip portion 130. Furthermore, distally-directed counter-forces applied to the endoscope 390, such as those resulting from use of other medical instruments or accessories within the integral working channels, may limit the amount of pulling force that can be applied.

FIG. 11B illustrates a side view of the distal tip portion 130 of the end cap 20 in which proximally-directed forces have been applied to the tissue 410 using grasping devices 420 a, 420 b in order to burrow the end cap 20 into the tissue 410, thereby causing localized retraction of a portion of the tissue 410 relative to the distal tip portion 130. The retracted tissue may include, for example, a tumor or other lesion to be resected using a knife or other cutting instrument. Advantageously, because the localized retraction is effected by pulling the tissue 410 onto the end cap 20 externally (as opposed to using dedicated retraction device(s) advanced through working channels of the endoscope), problems that might otherwise arise from using retraction and cutting devices simultaneously are avoided.

Although the device 10 in the above-described embodiments is configured to be removably affixable to an endoscope, it will be appreciated that the device 10 may instead be permanently coupled to an endoscope during its manufacture so as to form a single, integrated instrument. In other embodiments, features of the device 10 may be built into the design of an endoscope. FIG. 12 is a perspective view of the distal end of an endoscope 430 according to one such embodiment. As shown, the endoscope 430 may comprise a shaft having a plurality of working channels 440 a-440 o. Although the working channels 440 a-440 o in FIG. 12 are depicted as generally being the same size, it will be appreciated that the working channels may be of different sizes for accommodating different types of medical instruments and accessory devices. The working channels 440 a-440 o may be arranged in a “honeycomb” configuration, with at least two of the working channels having a common end cap 450 integrally formed over their distal ends. As shown in FIG. 12, for example, the end cap 450 may be formed over three working channels (e.g., working channels 440 m-440 o). In certain embodiments, of the channels contained under the cap 450, at least one may be configured to receive a camera, and at least one may be configured to receive a cutting instrument. In certain embodiments, the end cap 450 may comprise features similar or identical to the distal tip portion 130 described above in connection with FIGS. 3A-3B. Grasping devices 420 a, 420 b may be advanced through working channels adjacent the exterior of the end cap 450 (e.g., working channels 440 b and 440 h, respectively), or other working channels, in order to pull a portion of tissue 410 against the distal end of the end cap 450, thus providing the benefits described above in connection with FIGS. 11A-11B. Advantageously, because working channels integral to the endoscope 430 are used to deploy the grasping devices 420 a, 420 b, movement of the working channels relative to the end cap 450 as described above in connection with the device 10 is not necessary.

In certain embodiments, devices and instruments described hereinabove can be designed to be disposed of after a single use, or it may be designed to be used multiple times. In either case, however, the devices and instruments can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device or instrument, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device or instrument can be disassembled, and any number of the particular pieces or parts of the device or instrument can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device or instrument can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device or instrument can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device or instrument, are all within the scope of the present application.

Preferably, the various embodiments of the devices and instruments described herein will be processed before surgery. First, a new or used device or instrument is obtained, and, if necessary, cleaned. The device or instrument can then be sterilized. In one sterilization technique, the device or instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and device or instrument is then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the device or instrument and in the container. The sterilized device or instrument can then be stored in the sterile container. The sealed container keeps the device or instrument sterile until it is opened in the medical facility.

It is preferred that the devices or instruments are sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam.

Those of ordinary skill in the art will appreciate that embodiments of the device 10 disclosed herein may also be provided in kit form. For example, a kit may include the surgical device 10 of FIG. 1 in combination with a flexible endoscope having at least one integral working channel.

It is to be understood that the figures and descriptions of the present application have been simplified to illustrate elements that are relevant for a clear understanding of the disclosed subject matter. Those of ordinary skill in the art will recognize that these and other elements may be desirable. However, because such elements are well known in the art and because they do not facilitate a better understanding of the present application, a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent that various modifications, alterations and adaptations to those embodiments may occur to persons skilled in the art with the attainment of some or all of the advantages disclosed in the present application. In certain embodiments, for example, the translating mechanism 50 may comprise more than one translating member 290. In one embodiment, for example, separate translating members 290 may be provided for each distal end 40 a, 40 b. Similarly, it will be appreciated that the translating member(s) may be slidably disposed in any number of tubes. In one embodiment, for example, translating member(s) may be contained in a single tube connecting the end cap 20 to the handle portion 60. It will be appreciated that it may be necessary to suitably configure the end cap 20 and the handle portion 60 to accommodate the number of translating members and tubes used. Additionally, while the actuator 80 in the above-described embodiments is in the form of a knob and shaft combination, it will be appreciated that other types of manually-operated actuators for causing the translating member 290 to translate axially, such as, for example, trigger actuators or lever actuators, may alternatively be employed. It will further be appreciated that electrically-powered actuators, such as, for example, motors or solenoids, may be used instead of a manual actuator. It is therefore intended to cover all such modifications, alterations and adaptations without departing from the scope and spirit of the present application as defined by the appended claims. 

What is claimed is:
 1. A surgical device for use with an endoscope, the device comprising: an end cap removably affixable to a distal end of the endoscope such that at least a portion of the end cap distally extends beyond the distal end of the endoscope, the end cap defining a through bore for receiving the distal end of the endoscope, and the end cap comprising an outer surface, a first circumferential track, and a second circumferential track; a first working channel having a distal end disposed in the first circumferential track and circumferentially movable along a length of the first circumferential track about a longitudinal axis defined by said through bore between a first position and a second position relative to said through bore; and a second working channel having a distal end disposed in the second circumferential track and circumferentially movable along a length of the second circumferential track about the longitudinal axis defined by said through bore between a first position and a second position relative to said through bore.
 2. The device of claim 1, comprising: a translating mechanism coupled to the end cap and to the distal end of each of the first and second working channels; and an actuator coupled to the translating mechanism to cause the translating mechanism to move the distal end of each of the first and second working channels in unison between the first and second positions.
 3. The device of claim 1, wherein the distal end of each of the first and the second working channels comprises a ring slidingly disposed in the corresponding track.
 4. The device of claim 2, wherein the translating mechanism comprises a translating member slidingly disposed through at least one tube.
 5. The device of claim 4, wherein the translating member comprises at least one cable extending between a proximal end and a distal end of the at least one tube.
 6. The device of claim 5, wherein the at least one cable comprises a loop having a distal end that is split to define a first cable segment and a second cable segment.
 7. The device of claim 6, wherein each distal end of the at least one tube is connected to a corresponding opening in the end cap, and wherein the end cap is structured to route a portion of the first cable segment and the second cable segment over the first track and second track, respectively.
 8. The device of claim 4, wherein the actuator is disposed on a handle coupled to each proximal end of the at least one tube.
 9. The device of claim 8, wherein the actuator comprises a rotatable knob coupled to the translating mechanism via a shaft.
 10. A system, comprising: an endoscope; an end cap removably affixable to a distal end of the endoscope such that at least a portion of the end cap distally extends beyond the distal end of the endoscope, the end cap defining a through bore for receiving the distal end of the endoscope, and the end cap comprising an outer surface, a first circumferential track, and a second circumferential track; a first working channel having a distal end disposed in the first circumferential track and circumferentially movable along a length of the first circumferential track about a longitudinal axis defined by said through bore between a first position and a second position relative to said through bore; and a second working channel having a distal end disposed in the second circumferential track and circumferentially movable along a length of the second circumferential track about a longitudinal axis defined by said through bore between a first position and a second position relative to said through bore.
 11. The system of claim 10, comprising: a translating mechanism coupled to the end cap and to the distal end of each of the first and second working channels; and an actuator coupled to the translating mechanism to cause the translating mechanism to move the distal end of each of the first and second working channels in unison between the first and second positions.
 12. A surgical kit comprising: an endoscope; and a surgical device of claim
 1. 13. A surgical device for use with an endoscope, the device comprising: an end cap having a bore therethrough configured to removably receive a distal end portion of the endoscope therein, said end cap defining a first arcuate track and a second arcuate track; a first working channel having a first distal end disposed in the first arcuate track, wherein the first working channel is arcuately movable along a length of the first arcuate track about a longitudinal axis defined by said bore between a first position and a second position relative to said bore; a second working channel having a second distal end disposed in the second arcuate track, wherein the second working channel is arcuately movable along a length of the second arcuate track between about the longitudinal axis defined by said bore another first position and another second position relative to said bore; and a translating mechanism operably interfacing with said end cap and said first and second distal ends for selectively moving said first distal end between said first and second positions and said second distal end between said another first and said another second position.
 14. The device of claim 13 wherein said first distal end is substantially blocked by a corresponding portion of said end cap when said first distal end is in said first position and wherein said second distal end is substantially blocked by another corresponding portion of said end cap when said second distal end is in said another first position.
 15. The device of claim 14 wherein said first distal end is substantially unobstructed by the corresponding portion of said end cap when said first distal end is in said second position and wherein said second distal end is substantially unobstructed by the another corresponding portion of said end cap when said second distal end is in said another second position.
 16. The device of claim 15, wherein when the first distal end is in the second position, the first distal end may be longitudinally extended beyond a distal tip portion of the end cap and when said second distal end is in said another second position, said second distal end may be longitudinally extended beyond the distal tip portion of the end cap.
 17. A surgical device for use with an endoscope, the device comprising: an end cap having an opening therethrough for receiving a distal portion of the endoscope, the end cap comprising an outer surface, a first orbital track, and a second orbital track; a first working channel having a distal portion disposed in the first orbital track, the first working channel orbitally movable along a length of the first orbital track about a central longitudinal axis defined by the opening between a first position and a second position relative to the opening; and a second working channel having a distal portion disposed in the second orbital track, the second working channel orbitally movable along a length of the second orbital track about the central longitudinal axis defined by the opening between a first position and a second position relative to the opening.
 18. A surgical device for use with an endoscope, the device comprising: an end cap having an opening therethrough for receiving a distal portion of the endoscope, the end cap comprising an outer surface, a first arcuate track, and a second arcuate track; a first working channel having a distal portion disposed in the first arcuate track, the first working channel arcuately movable along a length of the first arcuate track about a longitudinal axis defined by the opening between a first position and a second position relative to the opening; and a second working channel having a distal portion disposed in the second arcuate track, the second working channel arcuately movable along a length of the second arcuate track about the longitudinal axis defined by the opening between a first position and a second position relative to the opening.
 19. A surgical device for use with an endoscope, the device comprising: an end cap having an opening therethrough for receiving a distal portion of the endoscope, the end cap comprising an outer surface, a first radial track, and a second radial track; a first working channel having a distal portion disposed in the first radial track, the first working channel radially movable along a length of the first radial track about a central longitudinal axis defined by the opening between a first position and a second position relative to the opening; and a second working channel having a distal portion disposed in the second radial track, the second working channel radially movable along a length of the second radial track about the central longitudinal axis defined by the opening between a first position and a second position relative to the opening. 